THIS MACHINE MOCKS FASCISTS

Don’t Panic: This is How it Works

I find it really hard to get terribly emotionally invested in the ups and downs of the health care reform legislation in Washington, not because I think we don’t need reform, but primarily because I find the play-by-play, who’s-up-who’s-down BS silly and perhaps a bit ahistorical as regards how legislation is done. I mean, really: What? The president is not getting 100% of what he wants out of Congress? What? The opposition is opposed? What? Some congressman with shaky re-relection chances is making a stink that looks good to the people back at home? What? Getting it all through the legislative process is taking longer than anyone expected? I am shocked and may become vaporous.

Seriously, this is what happens with legislation; moreover, this is what’s supposed to happen. It is not, in itself, terribly remarkable. I’m interested in the process and what’s coming out of it; I’m rather less interested in following it like it’s The Most Important Sports Championship Final Game EVAR. Watching commentators running around saying OMG the Blue Dogs are delaying the vote until September OBAMA’S ADMINISTRATION IS SO OVER or things of that ilk makes me want to reach for a firehose.

So: Deep breaths, everyone. When 2010 and 2012 come around, what people are going to remember is whether the health care reform package passed or didn’t, not whether there was a one-month delay in the vote. And even then whether it will KILL OBAMA is another matter entirely: HillaryCare imploding didn’t do much to keep Bill Clinton from getting re-elected in 1996, you may recall.

Post navigation

46 thoughts on “Don’t Panic: This is How it Works”

My concern isn’t the politics itself. My concern is that the politics is going to prevent real reform from happening and that what will get is more Rube Goldberg machinery tacked on to the crappy existing system that does little to address the problems.

It may but in my opinion expecting genuinely transformative health legislation on the first go-round is a tremendously optimistic position to take. As a matter of how these things generally get done, the first round is going to have to be the proverbial camel’s nose through the flap of the tent.

John, I think your “camel’s nose” analogy is pretty accurate. I’m primarily a healthcare writer and I imagine something will get passed, although I suspect very few people will be genuinely happy with it. I remain largely unconvinced that any president or Congress is capable of having the clout and persuasiveness (even when Obama was running an 80% approval rating) to upend the U.S. healthcare system and replace it with something reasonably functional. The American people don’t even know what they want except “free healthcare” which, my friends, ain’t gonna happen.

Exactly. You’ve summed up my feelings on this one exactly, John, both in the post and the above comment.

Which is why I haven’t written about it. I mostly don’t care about the process. The process is the same as it always is, no matter who is in the White House. There’ll be fighting and grandstanding and hyperbole and, hopefully, some fisticuffs. In the end everybody will compromise and nobody will get they want 100% and yet they’ll all claim victory. Then, five years down the line they’ll blame the other guys for the emerging problems. That’s how America works.

What I care about is the final product, and we’re a long ways from that at the moment.

But I don’t have to like it. It’s like that video showing the Republican senators refusing to definitively say that they do or don’t believe that Obama is an American citizen. (and for the record, I hold no illusions how a similarly silly but polarizing question would be answered by Democrats in the same position).

I don’t have a better solution, but the whole thing feels so…pathetic, somehow.

I could go on a ten page diatribe about healthcare, but I’ll just say, like others have said, the outcome is all that matters. Healthcare reform is very personal for me because my father has been diagnosed with a form of bone cancer, and while the disease itself seems to be pretty treatable, he’s going to have to be out of action for a few months to recover from the transfusion he ultimately needs. He can’t be sure that he’ll have a job to come back to, or health insurance afterwards.

It may be outrageously optimistic to hope for too much the first go around, but I really hope that if we don’t get everything, we at least get the basic stuff everyone can agree on. The simple measures that keep both providers and insurees from gaming the system. The impartial oversite commitee with the ability to reform provider fee schedules would be nice, etc… We don’t need a miraculous single payer system, but at least some vital tweaks would be life saving, literally.

Keep in mind that “fiscally conservative” is code for “corporate lapdog” so it’s not such a bad thing to be opposite of that, even if the truth is that fiscally liberal means they’ll only sell their second born to the insurance companies to get reelected.

I have pretty much stopped reading anything regarding health care in the U.S. because right now it is all about the minutae of congressional politics, and nobody (regardless of ideological stripe) has said anything new about health care.

I have even stopped watching Olbermann.

This coming from a guy who spent his Winter’s vacation in 2008 checking out the New Hampshire primary.

Cheers
Andrew

P.S. I am Canadian; like I said in New Hampshire you can take my health care card out of my cold dead hands.

Oh, I don’t think the failure of ObamaCare will necessarily result in an Obama defeat in 2012, though I wouldn’t mind if it did. It’s more likely, though, to result in a 2010 repeat of the Gingrich Revolution of 1994, which pretty much gridlocked Clinton’s Administration for the remainder of his Presidency and forced him to “triangulate” the Republican positions to maintain some level of relevance.

(I’m discounting the whole “Clinton impeachment” thing; Clinton largely brought that on himself by (a) screwing around with Monica, and (b) lying about it, which is what he was actually impeached for. In the words of Will Smith in Men In Black, “Don’t start nothin’, there won’t be nothin’!” And I don’t think something similar is likely to happen to Obama; he may be a socialist, but he’s not stupid.)

The thing I worry about is whether we actually have a “Gingrich” that can pull it off in 2010, and that, I don’t know.

Obamacare itself is likely doomed; the more Americans hear about the plan, especially how much it’s actually gonna cost, the less they like it. The fact that a vote is being delayed until September just gives the opposition time to rally and turn public opinion further against it. This “overreach” will cost Obama, big time…and none too soon either, in my opinion.

Oh, I don’t think the failure of ObamaCare will necessarily result in an Obama defeat in 2012, though I wouldn’t mind if it did. It’s more likely, though, to result in a 2010 repeat of the Gingrich Revolution of 1994,

I personally am of the opinion that Obama has a better chance for reelection in 2012 if Republicans take one or both houses in 2010.

I think he will have very little chance of reelection if Democrats remain in control for the whole of his first term.

Well, despite the high probability that a certain capitalized phrase in your post has got you on the secret service watch list, I’ll offer my opinion here.

From what I’ve seen so far, Obama’s approach to legislation seems to be to let each chamber hash things out and only apply White House pressure when the chambers go to conference. This is a great approach for managing political capital, since it gives the greatest leverage for the least effort.

My problem in the specific case of healthcare reform is that the “sausage making” part of the legislative process that we’re in now seems too likely to come up with sausage, rather than any reform package that will actually work for the middle class. If neither the Senate bill or the House bill has a workable framework for consumers to get group-rate coverage regardless of their employment status, the whole process is useless. An individual mandate is just another $12,000 a year out of pocket for the middle class whose employer-based coverage could easily be dropped after reform takes place.

We’ll leave it to historians to gauge the impact that the Clintons’ healthcare reform efforts had on the Democratic Party’s 1994 election outcomes. I would assert the impact was less than you insinuate, but have no hard evidence to support my contention.

But I’ve got to respond to your comment that the thing you “really worry about” is whether the Republicans have, or can create, another Newt Gingrich to lead the revolution in 2010. I would say not to worry about that. Newt is a very smart man, well-educated and wise in the ways of Beltway politics. But it wasn’t Newt who created the Contract with America content. That was Ronald Reagan; he wrote most of that in 1985, nearly ten years before Mr. Gingrich (and others) stole it and pawned it off as a “Republican Revolution”.

1994 was a pendulum swing in reaction to decades of Democratic congressional misdeeds. It’s not going to make that kind of swing after four years. We are still well within the period where the public remembers the anger that caused the prior swing. Newt took advantage of an environment that existed…he didn’t create it out of whole cloth.

The sorts of people who will get upset at the failure to reform health care are also the sorts who will blame it on Republican obstructionism. In any case, I think that the elections in 2010 and 2012 are going to be much more driven by the shape of the economy as a whole than anything else. If things seem to have improved economically by this time next year, the Republicans are going to have an extremely time getting anywhere electorally.

Anyone who cares about government understands the need for compromise. Hell, comparing the legislative process to sausage making denigrates sausage making.

But, there are some compromises which essentially break the legislation. There is a monster in this latest version of “Healthcare Reform”: Businesses of under 50 people are excused from the compulsion to offer health insurance.

In case you were wondering, estimates seem to run up to about 60,000,000 people employed in 50< businesses. The lowest I've found s about 30,000,000.

Problem one is that many people are afraid that they’re going to lose their employer-supplied health care because of reform. What they don’t realize is that they could lose it anyway, whether there is expanded public health care or not.

That said, as the proprietor of this site has noted, this is the process. I’m glad that the process is working. Unlike the none process of the worst of the previous administration; people have forgotten what normal is.

Laura:
Healthcare has to be for profit because that is the motivation for the innovation that we enjoy today.

There are alot of problems in our current healthcare system that need to be solved, but if you want to stop future healthcare innovations, you know: new drugs, new screening tests, new implantable devices, and even better doctors, then kill the profit motive and shazam/presto no more significant innovation.

So, first of all, there is a world of difference between for-profit health care (which is what you’re defending, and badly), and for-profit health insurance …

… which I have never seen anyone even attempt to defend.

We could argue about the profit motive in health care – for instance, all the drugs that don’t get developed because they wouldn’t be sufficiently protectable, and do we really need this many medications to assist elderly males with, ehm, ‘relations’? But that’s all beside the point, because no proposal – not even single payer! – currently advocated is going to take the profit motive out of health care.

Single payer or the public option would do a serious number on the profit motive in health insurance – but I think that would be a good thing. After all, what innovation does an HMO foster? The excitement of not knowing if they’ll try to claim you’re not covered at the same time as they take your money?

between rescission and purging it is almost a sure thing that given the current system your father could never get worthwhile health insurance and the insurance industry would never fiscally allow any firm that wanted to hire him to do so.

John

We’ve been trying to start fixing the health insurance mess since at least FDR. I’m tired of watching reboot attempts of Round One over and over. I want to see Round One done and a strong start on Round Two this time.

Nick @ 18: Indeed, you’re right; there are few better things the Republicans could do than return to the principles of Ronaldus Maximus. They worked in the Eighties, and there’s no reason why they can’t work today.

But not only do you have to have principles, you have to have someone to sell them. It seems to me that that was Gingrich’s role in 1994. Who do we find to act as the salesman this time?

I’m getting a little tired of hearing this debate about “insurance”. You can’t insure against things that have a 1:1 change of happening or have already happened. It’s a terrible model to have.

People will get sick, the issue is the degree of “sick” they’re going to get and, sadly, eventually, almost everybody will get VERY sick and need something expensive. A tiny tiny minority of people might never need anything more than a course of antibiotics but they’re a minority.

The best you can hope for is hedging the risk around a large enough pool of people that some people will lose and some will win, but there’s not sane method of hedging that risk and not screwing people over.

As somebody said to me the other day: I don’t understand why people have a problem with a large, faceless bureaucracy when the government run it but not when a private company with shareholders does.

The rest of the industrial world seem to be able to manage this for a LOT less money than the US is actually spending, and most of them do it without noticeable rationing. I’m at a loss to understand why the French can do something Americans cant?’

Having lost wo people in my life because they had no insurance and let an illness become a death sentence. Something needs to be done. It is going to take some time but I am okay with that as long as it gets done.

Daveon @29: Because every time someone asks the question you just asked the big pharmaceutical concerns have a coronary and push their mouthpieces to scream “COMMIES COMMIES UNAMERICAN COMMIES SOCIALISM COMMIES WELFARE STATE COMMIES SOCIALISM BAD” until all the voices of reason are drowned out.

That’s the real kicker, isn’t it? Not too long ago FrontLine did a special on healthcare around the world. What they discovered is that nearly every 1st world nation on earth, and even a couple of the 2nd world ones, get better value for their healthcare dollar than we do here when measuring the health of the citizenry against how much they pay.

All had better health value per dollar, and they all had some form of universal healthcare. Alot of those countries implemented some really cunning ideas to make care delivery efficient, and it’d be pretty sad if we didn’t steal at least a few of those ideas because we didn’t come up with them, or we perceive they would never work here because {dubious reason X}.

We’ve been trying to start fixing the health insurance mess since at least FDR. I’m tired of watching reboot attempts of Round One over and over.

The elephant in the room, which no one wants to really discuss, is that the biggest cost driver for health-care is euphamistically called “utilization”; i.e. demands on the system.

Now its a fact that the most significant drivers of a long and healthy life come from areas not directly affiliated with the “health-care” system: nutrition, hygene, exercise and a good mental attitude.

Obesity, for instance, is a huge cost driver and is completely controllable on the personal level without having to deal with the health care system. Another cost-driver is medical problems that result of poor eating habits and lack of exercise.

Keeping oneself healthy is generally not rocket science but most people don’t want to pay attention to what they are doing to themselves. They want to do what they want and when it results (predictably) in poor health, they want doctors to fix them so they can keep doing what they want.

If everyone ate well, execized well, applied proper hygene and had a good mental attiude, there would be much less demand on the health care system and costs would go down.

That’s not to say that medical science is obsolete or not worth anything. Clearly antibiotics have had a large affect on longevity and there is a need to fix people’s bodies when they break. And it is good to fund research into cancer and stem-cells and the like and to apply that research.

But way too many people present themselves to the health-care system for ailments that result from situations that were completely under the control of the patient.

And then there is the fact that the vast majority of people want to live forever and demand the health-care system make it so.

Until someone comes up with a way to fix these things, health care costs are going to continue to spiral out of control. But once you try to address this, people will complain that you are trying “limit healthcare” which you will be doing.

The fact is single-payer government-run healthcare is not going to solve this problem and is a bad idea for a whole host of reasons not the least of which is that I do not want political decisions to impact healthcare delivery.

Back in the day, when I was young, President Kennedy focused people on exercise to the point that a physical fitness program was mandated in all of the schools. President Obama could do worse than reinstituting such a focus.

But besides that, revamping how we pay for healthcare shows quite a bit of promise. If all they do in Congress is work on that, I think their time would not be wasted.

The fact is single-payer government-run healthcare is not going to solve this problem and is a bad idea for a whole host of reasons not the least of which is that I do not want political decisions to impact healthcare delivery.

You had me until this paragraph. You say this, but then…

Back in the day, when I was young, President Kennedy focused people on exercise to the point that a physical fitness program was mandated in all of the schools. President Obama could do worse than reinstituting such a focus.

So political decisions impacting healthcare delivery = wrong.

Political decisions impacting lifestyle choices = right.

You can’t pick and chose this.

As I said, every single other industrial country, including the UK which has it’s own obesity and alcohol consumption related problems, have got solutions for this that a) work and b) cost their economies less to run than the US way.

Why is it assumed that Americans are less competent to run this stuff than the rest of us?

For full disclosure purposes, I now live in the US. I’m starting my own business and my wife was recently laid off so we’re on Cobra. But I am concerned that when that runs out we’re up the creek. She has a number of pre-existing conditions which can run to several hundred dollars a month in medication…

There’s a lot of illnesses out there that are genetic, or environmental or seasonal that have nothing to do with lifestyle.

All had better health value per dollar, and they all had some form of universal healthcare. Alot of those countries implemented some really cunning ideas to make care delivery efficient, and it’d be pretty sad if we didn’t steal at least a few of those ideas because we didn’t come up with them, or we perceive they would never work here because {dubious reason X}.

@ben, the bit I notice gets left of the soundbites I see from speeches is that while you can be left waiting in line for an operation in the UK. You are completely free to pay to jump the queue. Most employers offer “top up” insurance that actually works as insurance. The NHS is the gateway, but if you have something that can’t be treated by your GP straight away or needs specialists, the insurance kicks in to get you to see a private consultant and can get you to skip the queue for non-life threatening operations.

Of course, the other issue there is, if the illness is serious and life threatening – you’re generally going to get treated extremely quickly.

Where you hear some of the horror stories about people being refused treatment, the bit that rarely gets mentioned is that most people wouldn’t stand a snowball’s chance in hell of getting an insurance company to cough up for the treatment either.

The UK is fairly unique in having a completely free system. Most of the European countries have mixed private and public with a universal single payer system with mandatory private insurance, which is government backed, that people over a certain income have to pay for on top of the tax funded one.

I’m not in a panic. I’m getting pissed at the crap the insurance industry is pulling and the bribes they are making (in the form of political contributions).

Saw mention of a TV ad that is in the works. Two old geezers (husband and wife) are sitting at the kitchen table griping about how the new health care didn’t pay for his surgery (and so he’s going to die) but it will pay for other people’s abortions.

Apparently, no private health insurance corporate overlord ever turned down anyone for a medical expense. And apparently, if the life of a pregnant mother is in danger, then government paid health care should still not pay for it, because, you know, it’s abortion.

Frank@34 what would you rather control the health care you get; a system that is controlled by political pressure, or near monopoly that is controlled by how much money can be returned to the shareholders?

I am always amazed at the people who say they distrust the government for most things decide they want to trust it for healthcare.

Do you really want politicians to decide who is worthy of healthcare when? I mean it’s not like governments haven’t abused this power in the past and the more power you give a government the more it wants to use it “for the common good”.

So say mental health gets the government treatment and all the psychiatrists are employed by the government. Doesn’t the possibility of new “mental health conditions” be defined that require re-education cross anyones mind? Now you may implicitly trust the party you vote for but what if the evil opposition wins and takes control of the apparatus?

It is a fact that controlling costs means controlling access. And if there is only one provider of healthcare they are the supreme gatekeeper of access.

There are examples in history where access to healthcare took on ominous political tones. And even if not political, I can easily see where inhuman philosophies such as “utilitarianism” (the idea that healthcare should be prioritized in such a way that the most productive in society get preference) could gain ascendancy. I mean why not? You have to draw the line somewhere.

Now encouraging healthy lifestyles (not mandating them) is absolutely not that same thing, in my mind. So we had to do certain things as part of our physical education criteria; this did not extend past High School and no one is arrested for not exercising.

And besides that, government plans have little hope of being budget neutral as the President promised. People point to medicare as an example of a good government run healthcare program. But they neglect the fact that medicare is not solvent.

Unless and until medicare becomes solvent and “revenue-neutral” and the VA can get wait times for primary care to something more reasonable than 90 days (on average) I will not believe that the government is our best choice to deliver health care to the citizens of the United States.

I will not believe that the government is our best choice to deliver health care to the citizens of the United States.

And, having lived in several countries with single payer universal systems and now living in the US, I can safely say the way that healthcare is being delivered to citizens of the United States is by far and away the worst I’ve seen.

It isn’t about getting the government into healthcare, it’s about getting profit and the insane tracking/admin systems you appear to have in the US out.

Finally, promise: It is a fact that controlling costs means controlling access. And if there is only one provider of healthcare they are the supreme gatekeeper of access.

You’re creating a complete strawman here and dodging my original question. Why is it that Americans can’t manage something managed perfectly well, for less money by every single other Industrial country?

There doesn’t have to be one provider, there isn’t in the UK, France, Germany or many other countries, and even in some that only have the one provider we don’t see the situations arising that you seem to be afraid of.

I fail to see any difference between rationing medical services on economic grounds (money and insurance) versus medical need (doctors). In virtually every single country with universal healthcare the well off have the option to pay for themselves to jump any queues that form.

So why is it so bad to ensure a minimum level of healthcare for every citizen of the richest industrial country on the planet? If you have money it won’t affect you anyway, and done right, i.e. getting the admin out of healthcare it should save a metric shedload of money.

Agreed, but it still galls. My wife had health insurance when she got hospitalized, and the insurance company still took us for several thousand dollars. Were that to happen now, with us having kids and only one of us working, we’d probably lose our house at minimum.

Ultimately, we all have to get active about it if we want this problem fixed. The only thing that can push back against the entrenched financial interests and misinformation from big media outlets like Fox is for millions of angry Americans marching in the streets.

A shame that most of us are so apathetic and ignorant.

I’m Canadian (if only just since I moved to the states when I was six, and since got my American citizenship to vote against Bush and McCain) and I keep telling her that we need to move to Canada if reform doesn’t happen. Financially it’d be a wash, and if either of us did have health problems we’d come out ahead.

Most of my family lives in Ontario, and they’re a bit (a lot) confused by the spin against socialized medicine down here. They’ve had no problems with their health care system, from all my grandparent’s long term care, to my cousin’s husband throwing a clot into his brain, to a few other of my cousins having serious psychological problems. I’ve seen their health care system and how easily Canadians can get the care they want and need. What we have here in the states is a bad joke by comparison. Particularly when you consider that our health care system costs more of our GDP than theirs.

None of my family were ever told by an insurance company that the doctor they wanted was “out of network”, or that they couldn’t get essential surgery, or had at home care yanked, or any of the other BS that we Americans take for granted.

It’s like the fate lotto here. If you’re healthy you’re fine, get cancer or get in an accident, and even if you’ve got insurance you could be destroyed. Both financially and emotionally. What confuses me most is the Dumbocrats talking about health care as a financial issue, when Obama of all people should be talking about it as a MORAL issue. Just like all people should expect to have access to firefighters and police officers when they need them, a civilized society should provide health care to all of its citizens.

I think holding the VA up as the prime example of government-run care doesn’t really work.

The reason the VA in particular is the mess that it is today is because the bush administration, for the past however many years, has had to try to solve the problem of how to deal with the expenses of a war, while also performing tax cuts. The math didn’t work, so the answer they came to was to try to control the costs of the war. One of the big expenses for the war was medical/mental care for the growing number of injured/afflicted veterans that came back. Extreme pressure was put on the VA to find “some way” of reducing expenses, and that came out in denying/delaying care.

There are several books on this topic, and even more articles and interviews, but I’d say you shouldn’t read them unless you really want your blood to boil.

That said, you should read them.

Where was I? Government run care.
If you want an example of what we’re looking at, Medicare is a much closer example. People on medicare, overall, love it (even if many of them don’t even know it’s a government program. Read Paul Krugma’s blog.), and it’s not a means of providing care so much as paying for it. I don’t think many patients who need a bypass or a transplant wait much longer than a mouse click to get approved for whatever their doctor says the need.

Also, wanted to add. Right there with you on utilitarianism, though I don’t think it likely to become policy. Extreme theories of justice like that never really make it all the way, though there are hints of them here and there.

The part that always confuses me in this argument about socialized medicine is that we already have it here in the US. The VA is the perfect example, the government owns and runs the whole shebang from the hospitals to the doctors. That is not what the Democrats are trying to put into place. Ben is correct in that the best comparison is Medicare. Personally I think they should have just made everyone eligible for Medicare.

Comments are closed.

WHATEVER

Taunting the tauntable since 1998
John Scalzi, proprietorAbout the site